Are Collaborative Care Planning Teams and Technology the Key to Reducing Readmissions?

Tick tock goes the clock – in six short months the Centers for Medicare & Medicaid Services (CMS) will begin withholding 1% of Medicare inpatient payments for avoidable readmissions within 30 days. Peaking at 3% in 2014, this penalty has the potential to be a major financial hit to some hospitals already facing lower reimbursements. According to PriceWaterhouse Coopers Health Research Institute’s, “The Price of Excess: Identifying Waste in Healthcare”, preventable hospital readmissions are a significant avoidable cost in the U.S. health care system, costing an estimated $25 billion annually. Further noted by authors Stephen Jenks, MD MPH, Mark Williams, MD and Eric Coleman, MD MPH, poor discharge procedures and inadequate follow-up care lead to nearly one in five Medicare discharged patients being readmitted within 30 days. And across all insured patients, the preventable readmission rate is 11 percent, while the rate for Medicare patients is 13.3 percent.

While Jenks et al. noted that the highest rates of preventable readmission diagnoses are heart failure, COPD, psychoses, intestinal problems, and various types of surgery (cardiac, joint replacement, or bariatric procedures), the National Priorities Partnership estimates that total hospital readmissions could be reduced by up to 12% by improving proce­dures for admitting and dis­charging patients, providing better follow-up care and utilizing health information technology. With many readmissions costing between $6,000 and $10,000 each, a number of innovative solutions aimed at helping reduce avoidable incidents could be implemented:

If significant reductions in readmissions are to be achieved, a true system approach must be implemented with appropriate payment reform to bind payers, providers, physicians, pharma and specialty organizations to this important initiative. Reengineering current processes to include collaborative care teams and progressive information technology could be the key for improving transitions, reducing readmissions and delivering safe, quality, patient-centered care.